1. Diabetes Mellitus Part 2 Kathy Martin DNP, RN, CNE

2. Diagnostic Studies Fasting blood glucose > 126 mg/dl Random blood glucose > 200 mg/dl Two – hour OGTT with 75 g glucose load > 200 mg/dl Glycosylated hemoglobin – Hgb A1C – glucose attached to RBC for 120 days Goal < 6.5- 7.0% Monitored regularly Excellent test of overall disease management and client compliance with plan

3. Insulin Therapy  Normally excreted in small pulsatile increments (basal amount and meal related)  Patients are fearful of insulin  Commercially available insulin:  Rapid acting – lispro (Humalog), aspart (NovoLog)  Short acting – regular (Humulin-R), (Novolin-R)  Intermediate acting - NPH (Humulin-N), (Novolin-N)  Long acting – glargine (Lantus)

5. Lispro (Humalog, NovoLog) Rapid acting Clear Onset 0.25 hours Peak 1 hour Duration 3 –4 hours

6. Regular (Humulin-R, Novolin-R) Short-acting Clear Onset – 0.5 – 1 hour Peak 2 –3 hours Duration 3 – 6 hours

7. NPH (Humulin-N, Novolin-N) Intermediate acting Cloudy – Zinc added to prolong onset and duration of activity Onset – 2-4 hours Peak – 4 –10 hours Duration – 10 –16 hours

8. Glargine (Lantus), detemir (Levemir) Long-acting Clear Onset – 1 –2 hours Peak – none Duration – 24 + hours Do Not Mix with other insulins!

9. Insulin Therapy Insulins are often combined to achieve optimal blood glucose control Common regimens: Regular + NPH Rapid-acting + NPH Lantus (daily) + short acting (Regular or Rapid-acting) with meals Usually administered SQ Review mixing technique, administration sites Store in refrigerator (unopened) Vials stable after opened for 30 days (label) Pre-filled syringes stable up to 1 week in refrigerator

11. Alternative Delivery Systems Insulin pump Continuous SQ administration of “basal rate” with intermittent rapid-acting insulin Individualized to client’s dietary intake and activity level Used to achieve intensive insulin therapy outcomes of tight glycemic control Insulin pens Prefilled, portable